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Magnetic Resonance Cholangiopancreatography in Obstructive Jaundice

Vaishali, M. D. MD*; Agarwal, A. K. MD*; Upadhyaya, D. N. MS†; Chauhan, V. S. MBBS†; Sharma, O. P. MD*; Shukla, V. K. MCh†

Liver, Pancreas and Biliary Tract: Clinical Research

Goals: To determine the ability of magnetic resonance cholangiopancreatography (MRCP) to diagnose the level and cause of obstruction in patients with obstructive jaundice.

Background: The limitations of available imaging modalities have led to the increasing use of MRCP, which is a noninvasive and highly accurate technique in evaluating patients with biliary obstruction.

Study: Thirty patients were included in this study. MRCP was done using a fat suppressed, heavily T2 weighted fast spin echo sequence. The MRCP findings were confirmed on surgical exploration or clinical follow-up.

Results: MRCP could correctly identify ductal dilatation and the level of obstruction in all cases, except one. All causes of obstruction, except three, were detected. It failed to detect a common bile duct calculus in a minimally dilated ductal system and misdiagnosed a case of focal chronic pancreatitis as carcinoma head pancreas and a small pancreatic head mass as cholangiocarcinoma. It had a sensitivity of 94.44%, specificity of 81.81%, positive predictive value of 89.47%, and negative predictive value of 90% for the detection of malignant causes. The overall diagnostic accuracy for detection of level and cause of obstruction was 96.3% and 89.65%, respectively.

Conclusion: The high diagnostic accuracy of MRCP in evaluating patients with obstructive jaundice indicates that it has the potential to become the diagnostic modality of choice in such patients.

From the Departments of *Radiology and †General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.

Received for publication June 24, 2003; accepted May 17, 2004.

Reprints: Prof. V.K. Shukla, MCh (Wales), Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, India (e-mail: vkshuklabhu@satyam.net.in).

© 2004 Lippincott Williams & Wilkins, Inc.